Sr. Specialist, Quality Provider Engagement- RN / LPN Preferred (Remote)

Lensa; Biloxi (MS); Remote; USD 49,000 - 108,000; Full time

Job summary

A leading healthcare organization is seeking a Sr. Specialist in Quality Provider Engagement to implement strategies that enhance provider performance and achieve quality goals. This remote role requires strong communication and leadership skills, along with a background in healthcare or related fields. The successful candidate will work closely with healthcare professionals to drive improvements and maintain compliance. This position may involve significant travel, depending on location.

Qualifications

• Min 3 years experience improving provider Quality performance.
• Strong working knowledge of Quality metrics and risk adjustment practices.

Responsibilities

• Implement provider engagement strategy to achieve quality outcomes.
• Drive coaching and collaboration with providers to improve performance.
• Track engagement activities using standard tools and facilitate data exchanges.

Skills

Communication

Leadership

Data Analytics

Education

Bachelor’s degree in Business, Healthcare, Nursing or related field

Tools

PowerPoint

Excel

Visio

Job description

Sr. Specialist, Quality Provider Engagement- RN / LPN Preferred (Remote)

Sr. Specialist, Quality Provider Engagement- RN / LPN Preferred (Remote)

1 day ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

The Sr Specialist, Provider Engagement role implements Health Plan provider engagement strategy to achieve positive quality and risk adjustment outcomes through effective provider engagement activities. Ensures the core set of Tier 2 providers in the Health Plan have engagement plans to meet annual quality and risk adjustment goals. Drives coaching and collaboration with providers to improve performance through regular meetings and action plans. Addresses practice environment challenges to achieve program goals and improve health outcomes. Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for the Provider Engagement team. Communicates effectively with healthcare professionals and maintains compliance with policies.

Job Duties

• Ensures assigned Tier 2 & Tier 3 providers have a Provider Engagement plan to meet annual quality & risk adjustment performance goals.
• Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution.
• Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes.
• Drives provider participation in Molina risk adjustment and quality efforts (e.g. Supplemental data, EMR connection, Clinical Profiles programs) and use of the Molina Provider Collaboration Portal.
• Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness both within and across Molina Health Plans.
• Serves as a Provider Engagement subject matter expert; works collaboratively within the Health Plan and with shared service partners to ensure alignment to business goals.
• Assist Provider Engagement Specialists with training and problem escalation.
• Accountable for use of standard Molina Provider Engagement reports and training materials.
• Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
• Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by Plan and Corporate policies.
• Communicates comfortably and effectively with Physician Leaders, Providers, Practice Managers, Medical Assistants within assigned provider practices.
• Maintains the highest level of compliance.
• This position may require same day out of office travel approximately 0 - 80% of the time, depending upon location.
  
  

Job Qualifications

REQUIRED QUALIFICATIONS:

• Bachelor’s degree in Business, Healthcare, Nursing or related field or equivalent combination of education and relevant experience
• Min 3 years experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.
• Experience with various managed healthcare provider compensation methodologies including but not limited to: fee-for service, value-based care, and capitation
• Strong working knowledge of Quality metrics and risk adjustment practices across all business lines
• Demonstrates data analytic skills
• Operational knowledge and experience with PowerPoint, Excel, Visio
• Effective communication skills
• Strong leadership skills
  
  

Preferred Qualifications

Min 3 years experience improving Quality performance for Medicaid, Medicare, and/or ACA Marketplace programs

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

#PJCorp

Pay Range: $49,430.25 - $107,098.87 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
  
  

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance

• Industries

  IT Services and IT Consulting

Referrals increase your chances of interviewing at Lensa by 2x

Get notified about new Senior Quality Specialist jobs in Biloxi, MS.

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.